Provider Demographics
NPI:1093458077
Name:WOODARD, BOBBY R JR (DPH)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:R
Last Name:WOODARD
Suffix:JR
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 N. 24TH W: AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127
Mailing Address - Country:US
Mailing Address - Phone:918-592-2118
Mailing Address - Fax:918-430-0118
Practice Address - Street 1:WESTVIEW PHARMACY
Practice Address - Street 2:3606 N. MARTIN LUTHER KING
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106
Practice Address - Country:US
Practice Address - Phone:918-425-1385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist